IvyPlus Exchange Scholar Program Application
Purpose
The IvyPlus Exchange Scholar Program enables a graduate student enrolled in a doctoral program in one of the participating institutions to study at one of the other participating graduate schools for a limited period of time at no additional tuition cost, in order to take advantage of educational opportunities not available on the student’s home campus.
Duration of a participating student’s enrollment at a host school may be for one or more terms (which may be recorded in quarters or semesters, depending on the institution), with a maximum exchange enrollment of one year. (In the case of a student accompanying a dissertation adviser who has joined the host school, more than a year’s enrollment as an Exchange Scholar may be permitted if all parties are in agreement.) Any extensions to an approved exchange enrollment require a separate application form.
The academic experience, including courses taken and/or research conducted with particular faculty at the host institution, is reported to the student’s home institution to be recorded on the academic record maintained by the home institution. It may also be recorded by the host institution. Participating students may be required to confirm the transfer of credit with their home institution.
Eligibility and Application Process
Terms and conditions for the IvyPlus Exchange Scholar Program are found at the end of this application. The graduate schools of the institutions listed at the end of the application are participants in the IvyPlus Exchange Scholar Program. If a student is currently enrolled in a doctoral program at one of these institutions and wishes to study for a term or academic year at another, the student should read the relevant terms and conditions and complete the application as instructed. All approvals from the home and host institutions must be obtained at least two months before the enrollment date at the host institution. Most participating institutions can enroll exchange students only at the start of a term. Please refer to a host institution’s academic calendar for relevant dates.
Please be aware that a host institution may charge an application fee or fees for services that are not covered by tuition, such as health and hospitalization charges. It is a student’s responsibility to meet such charges.
International students on a F-1 or J-1 visa may remain on the visa sponsorship of their home institutions and maintain their immigration status. They must contact their home institution’s international student office before accepting any on-campus or off-campus employment.
Effective Dates The IvyPlus Exchange Scholar Program was renewed in September 2018 for a five-year period. However, the participating institutions may modify the program at any time, and individual institutions may withdraw from the program at any time.
1 Please do not use the Mac built-in Preview application to fill out this form. Rather, download Adobe to complete the form.
Parts of the Application
Each part of the application must be completed. • Parts A through C are completed by the student applying for the exchange. • Part D is completed by the administrative contact at the home institution. • Parts E and F are completed by the administrative contact at the host institution.
The roster of administrative contacts is found at the end of the application, along with terms and conditions.
A. Student Information. Please print or type all information.
Legal Name (last, first and middle)
Preferred Name (if applicable
Name of Home Institution
Student ID number at Home Institution
Date of Birth Legal Sex (for government reporting)
Email address at Home Institution
Country of Citizenship
Birthplace (City, State, Country)
Visa Status (international students only, F-1 or J-1)
For students in the U.S. on a student visa, the home institution will continue to issue certificate of eligibility (I-20 or IAP-66).
In your home institution program:
Doctoral Degree Program (e.g., History, Chemistry) Term of initial registration or enrollment (e.g., Fall 2017) Expected completion date of degree (e.g., May 2023)
2 Quarter(s)/Term(s)/Semester(s) you propose to spend at the host institution (e.g., Fall 2020, Spring 2021). Please check with the host school exchange administrator first if you are proposing to visit during a time that includes a summer term. Not all institutions can accommodate the exchange during a summer term.
Have you participated in the Ivy Plus Exchange Scholars Program before? Yes No
If yes, when and where?
Name of Proposed Host Institution
Department or Program at Host Institution
Subfield, subject or area of concentration
Adviser at Host Institution (if applicable)
Address to which bills or other information should be sent:
Address 1
Address 2
City/State/Zip
Telephone
Please describe your proposed plan of study during the exchange and indicate why it is essential to your degree program. (Attach another page if necessary.)
If you plan to enroll in courses at the host institution, please provide the following information on the courses you wish to take. Enter information exactly as it appears in the host institution’s course offerings. Note that some departments at a host institution may not allow exchange students to enroll in their courses.
3 Attach email correspondence showing approval by the instructor(s) of the course(s) you wish to take. Correspondence should be from the university email account of the instructor(s) and explicitly state the course number, title and term, as well as approval.
Term Course No Course Title Credit Basis Instructor Name
Funds for support for the requested period of study are available as follows: Source Type Tuition Living Stipend
(e.g., Home Inst, External) (e.g. Fellowship, Research asst., Loans) ($ amount) ($ amount)
Ordinarily students will not receive any financial support from the host institution. Will any financial support come, or be paid through, the host institution, for example as an assistantship in research or teaching fellowship? YES NO
If yes, and if you are an international student on a visa, you must contact the visa office at your home institution, as well as the visa office at the host institution, prior to your arrival.
Do you require support from the Accessibility or Disability Services Office at the host institution? YES NO Note: If yes, contact the relevant office at your home institution and ask that that office make contact with the relevant office at the host institution. The administrative contacts for the exchange at both the home and host institutions can help with referrals to the appropriate offices.
Sign the following statement:
I hereby petition to participate in the IvyPlus Exchange Scholar Program and to undertake the course of study outlined above. I agree to abide by the terms and conditions of this program as well as the regulations and procedures of both institutions. I understand that violation of any of the regulations can result in my suspension from the program. I authorize the transfer of record of courses and/or research conducted with a particular faculty member at the host institution to my home institution and understand that I may need to request this transfer separately.
Student Signature Date
4 B. Approvals.
Obtain the signed approval of the following individuals at your home institution. Emailed approvals may be accepted by the administrative contact only if they are from the university email account of the signer and explicitly state the exchange dates and host institution, as well as approval of participation as described in the application.
1. Academic Adviser
Name Title Signature Date
2. Director of Graduate Studies or Department Chair
Name Title Signature Date
C. Submission.
Submit this form to your home institution administrative contact for review, approval, and processing. Administrative contacts are listed at the end of the application. Only the administrative contact may forward applications to the host institution.
Administrative Contact for Exchange
Name Title Signature Date
D. Home Institution Administrative Contact.
The home institution administrative contact should review Parts A-C of this application. If approved, please make sure your signature appears in Part C and then forward this application to the IvyPlus Exchange Scholar Program administrative contact at the host institution the student plans to visit.
E. Host Institution Administrative Contact.
Please obtain the approval of the following persons for the student’s proposed course of study at your institution. (You sign in part E-3.) Emailed approvals may be accepted if they are from the university email account of the signer and explicitly state the exchange dates and host institution, as well as approval of participation as described in the application.
5 1. Academic Adviser (if relevant)
Name Title Signature Date
2. Director of Graduate Studies or Department Chair
Name Title Signature Date
3. Administrative Contact for Exchange
Name Title Signature Date
F. A complete and signed application should be held at the host institution for administrative processing. Copies of the complete and signed application with any attachments should be returned to the student and to the administrative contact at the student’s home institution.
6 PARTICIPATING INSTITUTIONS AND ADMINISTRATIVE CONTACTS
University of California at Berkeley All Ph.D. programs Contact: Maritsi Perez Degrees Office, 318 Sproul Hall, #5900 Berkeley, CA 94720-5900 Phone: 510.642.7330 Fax: 510.643.1524 Email: [email protected] or [email protected] Academic calendar: http://registrar.berkeley.edu/CalendarDisp.aspx?terms=current
Brown University All Ph.D. programs Contact: Thomas Lewis Associate Dean of Academic Affairs Brown University Box 1867 Providence, RI 02912 Phone: 401.863.1181 Fax: 401.863.3471 Email: [email protected] Academic calendar: http://www.brown.edu/Administration/Registrar/calendar.html
University of Chicago All Ph.D. programs Contact: GRAD Exchange UChicagoGRAD 970 E. 58th Street Chicago, IL 60637 Phone: 773.702.3760 Email: [email protected] Academic calendar: http://www.uchicago.edu/academics/calendar
Columbia University All Ph.D. programs Contact: Richard Slusarczyk Associate Dean of Academic and Student Affairs Columbia University 107 Low Library 535 West 116th Street New York, NY 10027 Phone: 212.854.8428 Fax: 212.854.4912 Email: [email protected] Academic calendar: https://registrar.columbia.edu/calendar Cornell University All Ph.D. programs Contact: Anne Haessner, Assistant Registrar Cornell University 143 Caldwell Hall Ithaca, NY 14853-2602 Phone: 607.255.5862 Fax: 607.255.1816 Email: [email protected] Academic calendar: http://www.cornell.edu/academics/calendar/index.cfm
Dartmouth College All Ph.D. programs Gary Hutchins Assistant Dean and Graduate Registrar Guarini School of Graduate and Advanced Studies 64 College Street, Suite 6062, Room 103 Dartmouth College Hanover, NH 03755 Phone: (603) 646-2107 Fax: (603) 646-8762 Email: [email protected] Academic calendar: https://www.dartmouth.edu/reg/calendar/academic/index.html
Harvard University All Ph.D. programs in the Graduate School of Arts and Sciences Contact: Shelby Johnson Assistant Director of Student Affairs Graduate School of Arts & Sciences Harvard University Smith Campus Center 350 Cambridge, MA 02138 Phone: 617.495.2815 Fax: 617.495.2928 Email: [email protected] Academic calendar: http://www.registrar.fas.harvard.edu/calendar/five-year
Massachusetts Institute of Technology All PhD programs with approval of the host department Contact: Blanche E. Staton Senior Associate Dean for Graduate Education Office of the Dean for Graduate Education M.I.T. 77 Massachusetts Avenue Room 3-138 Cambridge, MA 02139-4301 Phone: 617.253.4869 Fax: 617.253.5620 Email: [email protected] Academic calendar: http://web.mit.edu/registrar/www/calendar.html
University of Pennsylvania All Ph.D. programs Contact: Patricia Rea Associate Director of Admissions University of Pennsylvania 3401 Walnut Street, Suite 322A Philadelphia, PA 19104-6228 Phone: 215.898.8101 Fax: 215.573.8068 Email: [email protected] Academic calendar: https://almanac.upenn.edu/penn-academic-calendar
Princeton University All Ph.D. programs Contact: Elaine Willey Assistant Dean for Academic Administration Princeton University Clio Hall Princeton, NJ 08544 Phone: 609.258.3033 Fax: 609.258.6180 Email: [email protected] Academic calendar: http://registrar.princeton.edu/academic-calendar/
Stanford University All Ph.D. programs (except those in Graduate School of Business and Stanford Law School) Contact: Laura Remillard Associate Director of Graduate Admissions Stanford University 408 Panama Mall, Suite 217 Stanford, CA 94305-6032 Phone: 650.475.6075 Fax: 650.723.8371 Email: [email protected] Academic calendar: https://registrar.stanford.edu/resources-and-help/stanford-academic-calendar-2019-20
Yale University All Ph.D. programs Contact: Jasmina Besirevic Regan, Associate Dean for Partnerships and Special Projects Christina Albino, Administrative Assistant Yale Graduate School of Arts and Sciences P.O. Box 208236 New Haven, CT 06520 Phone: 203.432.7598 Email: [email protected] or [email protected] Academic calendar: http://www.yale.edu/calendars/ Terms and Conditions The following are to be regarded as minimal terms and conditions of the program. Individual institutions may choose to establish more rigorous criteria, e.g., for eligibility or duration of study. Definitions (e.g., of “term,” “academic year,” and “hospitalization coverage”) may also vary according to local policy and practice.
1. ELIGIBILITY – Normally students will be eligible to be Exchange Scholars only after they have completed one full academic year in residence in a Ph.D. program at their home institution. Students must be in good standing at the home institution at time of application and for the duration of the exchange period. 2. DURATION – A minimum of one term of study and a maximum of one academic year will be permitted in the program. The operation of this program during the summer sessions will be at the discretion of the host and home institutions. Any extensions require separate approval. 3. REGISTRATION STATUS – Exchange Scholars will be registered by the home and host institutions in whatever enrollment category (“in absentia,” “in residence,” “special student,” “Exchange Scholar”) is appropriate at each place. 4. TUITION AND FINANCIAL AID – Tuition will be charged and collected by the student’s home institution. Stipend support, if any, is ordinarily paid only by the home institution. 5. HEALTH AND HOSPITALIZATION COVERAGE – The host institution will be responsible for assuring that hospitalization and health services are locally available. However, the host institution may either charge the student for such services or require that the student is covered by the student health plan of the home institution. 6. RESPONSIBILITIES AND PRIVILEGES – Relevant rules, policies, and procedures for the home institution and the host institution apply to Exchange Scholars. At the host institution, Exchange Scholars will be accorded many of the privileges of the host institution’s degree-seeking students. They will receive a student ID card that permits access to the host institution’s libraries, labs, health facilities, athletic facilities, etc. Where these services entail fees in addition to tuition, the host institution will charge Exchange Scholars the same fees it charges its own graduate students. Host institutions reserve the right to limit Exchange Scholars’ access to resources that are specifically dedicated to students who are pursuing a degree program or for which such students have priority. 7. INTERNATIONAL STUDENTS - International students are understood to be under the continuing sponsorship of their home institution. All US Immigration Services work for them must be done through the international student advisor at the home institution. International students on F-1 visas should note that they are not allowed to work at the host institution unless they obtain prior written approval from the Visa Office at the host institution. 8. RECORDS – Upon completion of an Exchange Scholar’s enrollment at a host institution, an official transcript may be sent to the student’s home institution. Participating students and administrative contacts should confirm this process with the host institution administrative contact; at some institutions, students or administrative contacts may need to request the transcript themselves. The transcript will include the course record (title, number, instructor, credit or class hours and grade received), if any, and may include any research or independent study courses the student completed. The information will then be posted on the student’s academic record or made part of the record as appropriate to the home institution. 9. NOTIFICATIONS – The host institution may notify the home institution about the student’s program, experience, and conduct during the exchange period. The home institution will be responsible for notifying third parties of the Exchange Scholar’s status and activities.